Treat The Cornea Or The Lens? Refractive Rehabititation Startegies In Cornea Plana

To present a practical surgical approach to refractive rehabilitation in patients with cornea plana and to discuss decision-making between lens-based and corneal-based strategies.

Tertiary referral and private anterior segment surgical practice

A clinical case-based analysis of patients with cornea plana undergoing either phacoemulsification with intraocular lens implantation or corneal transplantation. Preoperative assessment focused on keratometric extremes, anterior segment configuration, axial length considerations, and refractive goals. Surgical planning, intraoperative modifications, IOL power calculation challenges, and postoperative visual rehabilitation strategies are illustrated through clinical images and surgical video excerpts.

Lens-based surgery in selected cases allowed functional visual rehabilitation while avoiding graft-related risks. Corneal transplantation altered corneal curvature but introduced refractive variability and prolonged recovery. Critical factors influencing surgical choice included corneal clarity, degree of refractive error, anterior chamber anatomy, and patient age.

In cornea plana, surgical management should be guided by refractive objectives rather than anatomical abnormality alone. A structured decision-making approach can help surgeons determine when to treat the lens, when to address the cornea, and how to optimize refractive outcomes in this rare condition.